Tuesday, February 12, 2013

APTA Clarifies Key Points of Medicare 'Improvement Standard'

APTA's issue brief on the final
settlement in the class action "Improvement Standard" lawsuit (Jimmo
vs Kathleen Sebelius), which upheld the right of patients to continue to
receive reasonable and necessary care to maintain their condition and prevent
or slow decline, contains key points for physical therapists regarding
compliance with this Medicare regulation.

In the brief, APTA notes that there is "clear and convincing evidence embedded within the
provisions of the current Medicare regulations that providers may use to
justify the current practice of providing skilled therapy to patients to
maintain their current level of function or to prevent decline or
deterioration." Thus, the final settlement seeks to clarify the
regulations; it does not expand the Medicare benefit.
"Therefore, we expect that only patients who were unfairly denied services
based on this arbitrary standard will now have access to care," says the
brief.

APTA
members can access the issue brief on the Medicare Coverage Issues webpage under the
subtitle Improvement Standard.